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Procedure: FAQ Facelift

FAQ Facelift

1. I am confused Doctor. There are so many types of facelifts. Which one is right for me?

This is understandable since it can even be confusing to Plastic Surgeons! One must first understand that the face is arbitrarily divided into thirds. The upper third represents the upper eyelid and brow. The middle third is the area from the lower eyelids to the corner of the mouth. This includes the nasolabial folds and under eyelid hollows. The lower third is measured from the corner of the mouth past the jawline onto the neck.

An endoscopic brow lift addresses the upper third. These are done through 4 small incisions behind the hairline with a small camera and specialized instruments.

Only a traditional/regular facelift (one which involves incisions in and around the ear) rejuvenates the lower 2 areas.

A midface lift (AKA vertical lift, subperiosteal lift, Minimal incision lift) effectively reverses aging in the midface ONLY- the jowls and neck will not be helped by this latter technique alone. The Midface lift involves hidden incisions within the hairline and mouth and is possible through the use of small cameras and an Endotine device( It is ideal for those that want subtle changes who are in their midthirties to forties. Sometimes a midface lift will be combined with a regular facelift for an enhanced result. I will listen to your concerns and devise a customized surgical strategy depending on the state of your tissue and your specific goals.

Thread lifts (Contour ??and Feather Lifts??) are interesting new concepts in facial rejuvenation. Barbed sutures(like fishing line) are threaded through and hooked into the superficial facial tissue under local anesthesia and then pulled upwards. However, results so far do not match up to either regular or midface lifts in terms of efficacy or longevity. They last only about 18 months, but they may be appealing because no significant incisions are involved, they can be performed under local anesthesia in a dental chair and are relatively less expensive.

2. You didn't mention the Short Scar facelift, MACS lift, S.O.M.E. facelift, E.S.P./skin only facelift, deep plane facelift or composite facelift. What are those?

Good question. These are all variants of regular facelifts but differ in how the tissues just below the skin are surgically manipulated to enhance the rejuvenation of the face. Laymen often refer to these deeper tissue maneuvers as "tightening the muscles". As plastic surgery evolved and became more sophisticated in its understanding of facial aging, it became apparent that facelifts must do more then just tighten and cut out extra skin. They must also elevate the deeper fatty tissues which also sag with age in order to fully address the aging process at all levels.My procedure of choice is the S.O.M.E. facelift.

3. What areas of the face will a regular facelift help?

The midface, the jowls and the neck.

4. Won't the scars around the ear be visible?

Not necessarily. Meticulous attention to detail with a discerning eye separates an exceptional plastic surgeon from a good one. The way the incision is designed in and around the ear, the style with which the skin is tailored and sutured closed and the force with which the skin is pulled all play significant roles in the final appearance of the scar; or should I say disappearance? My goal is to have you feel absolutely confident in wearing your hair up or short in public., completely forgetting that you had a facelift in the first place.

Invisible Facelift Scars Invisible Facelift Scars
Typical near-invisible facelift scars produced by Dr Haworth. Typical near-invisible facelift scars produced by Dr Haworth.

5. What is fibrin glue?

This is a true advance in facelift surgery in that it dramatically reduces the postoperative bruising and swelling associated with the procedure. As an added benefit, it allows the surgeon to forgo the use of annoying drains after surgery while virtually eliminating the chance of hematoma formation. It is a human-derived plasma product tested for HIV and hepatitis and used extensively in cardiac and neurosurgery. In facelift surgery, it is sprayed on all the raw surfaces to seal off most blood vessels and lymphatic channels not visible to the naked eye. This latter effect accounts for the rapid initial recovery seen in my facelift patients along with my use of electrocautery to perform most of the dissection. Electrocautery dissection eliminates most blood loss during surgery, further minimizing postoperative bruising and swelling.

6. How long is the surgery and what are the the most common risks with it?

A regular facelift without browlift ,eyelid or lip surgery takes about 3 to 3.5 hours to perform. A midface lift takes about one hour to perform. With modern anesthesia it is all exceptionally safe surgery, however, regular facelift surgery patients need to be monitored by a healthcare professional for the first night after the procedure. This is most commonly done in a specialized aftercare facility. The reason for this is to check for the early signs of a hematoma (a blood collection under the facial skin), probably the most common complication after a facelift. Despite it being a very rare occurrence (especially with the use of fibrin glue), it is important to catch it early if it does occur so that it can be corrected rapidly.

7. When can I go in public?

Most patients are "restaurant-ready", perhaps with some strategic coverup in about 7-10 days. This time period will be longer if you get your lips enhanced at the same time. Most stitches are removed at 5 days and the last hidden ones are removed at 10.

8. How much pain will I be in Doctor?

Actually, very little. All facial procedures (including regular and midface lifts) are normally associated with some degree of numbness, stiffness and tightness. Stiffness with minor impairment of your full denture smile can last up to 3 months while sensation starts returning after a couple of weeks. Despite the lack of pain we still administer pain medicine just in case you need it.

9. Will I lose any hair?

With the modern techniques of facial rejuvenation and specialized modifications that I have developed, hair loss is a very rare occurrence. However, if a small patch of hair loss develops it is an easy thing to correct.

10.How long will my facelift last?

Regular facelifts last from 7-12 years, depending on the individual's tissue makeup. It is not that facelift suddenly falls apart at 12 years, but you will gradually note that the general signs of aging start to catch up again around this time. "Plastic surgery reverses time, but time still marches on." -Dr Haworth.

Randal Haworth, MD
436 North Bedford Drive Suite 105
Beverly Hills, CA 90210
(310) 273-3000 (310) 273-8802 Monday through Friday, 9 a.m. to 5 p.m.